developments that occurred. we have a donate button. we would be very much encourage your viewers to make a donation. it's a wonderful opportunity to do so. it's a wonderful opportunity to show they think it's a good idea. why it's important as we go out to the major funders, it will be helpful for us to be able to show and hear a lot of people have already donated and shown their interest and how important this is to the donation. so i would encourage all of your viewers to do that no matter how modest. $50, $25, the numbers are more important at this point. >> and two -- of your favorite american authors from your past or current? >> i have children and grandchildren, that's like schedule me who is my favorite child or grandchildren. there are so many. it we are blessed that there are so many. i certainly have grown up as a
student reading hemmingway and stenbeck. i have gravitated toward the poet. i love the great poet who can't? , i mean, i have -- sitting on my night stand, which i turn to every night and every morning. so there's so many. i hate to think about one or two. >> malcom 0 hagueen is the founder and chairman of the foundation of the american writers museum inspect is booktv on c-span2. booktv will be live at the miami book fair international held on the miami decade college. we'll bring you ten author talks and panel discussions. seven author interview segment
and your chance to interact with facebook, twitter, and calls and e-mails. featured authors include bill 0 riley in -- up next beatrix hoffman presents a history of the american health care system. she presents her thoughts on why the united states has been one of the few developed countries to not adopt universal health care. and exams why the issue is so devicive. it's just under an hour. [inaudible conversations] hello, everyone, i'm gail davis president for academiaic student
affairs here and former faculty member of women history. i'm delighted to be here and happy we're sponsoring the program. thank you to all of you and thank you, gretchen for the nice introduction. it's really going to be the best of our pleasures to introduce dr. beatrix hoffman to you. she's the leading historian of u.s. health care systems. [inaudible] very busy during the political season, beatrix, debate about what is best in health care, what is best in health care insurance, what is best for women's health care rights being in the air, everywhere you look these days. so as a -- [inaudible] and ak keepic in women history, i'm sure all of us are looking forward to the presentation. thank you for being here.
you couldn't be in a better time for this talk either. such much of grand rap pieds has been very highly invested in the health care industry. hoping to develop seller health education, research, innovation in practice, all in the quest for great health care here. i hope some of the visitors to town will be able to see what we call health bill on michigan so much of the investment in medical health-related work has been made. dr. hoffman is professor and chair and department of history at northern illinois. dekalb illinois. she completed her ph.d. as it seems everyone at my table did at rutgerss university in 1996. she's written expleasantively on the american health care reform
including 2001 book spite latitude and longitude the wages of sick pes, the politics of health insurance, and progressive america. that the university of north carolina put out. this is a history -- her book and rather her talk today will be partly the history of rights and rations in the united states from the great depression to the present and the book just came out this month by the university of chicago press. i have seen copies of it flying around. i wish i had one to hold up here. by all accounteds, dr. hoffman
has simply nailed this big historical topic up to the present moment. i'm going read a few blerp from the early review how that is being received. author of the "healing of america" writes this, in the american political debate, everybody condemns the notion of rationing health care. but beatrix hoffman's history shows that rationing by income, age, employment, et. cetera has been and remains a central element of america's medical system. she demonstrated that our various attempts at reforms over the decades have kept the rationing mechanism firmly in place. talk about death panel too -- i don't know if that is. johnathan writes, excuse me, my
allergies are showing up this morning. chronical america's struggles to make health care a right from the depression through obamacare. hoffman's beautifully written the account exemployees the racings of medical care and insurance in the unequal health system. "health care for some" is a compelling reminder of how far we have come, but also how far we reforms still has to go in the united states. the reviews keep this tone throughout. beautifully written, insightfully described and researched. this bock is a must read it sounds like to me. thank you so much for your work. i know, we're in for a treat right now. let me get out of the way and join me, please, in welcoming dr. hoffman to the stage. [applause] [applause]
thank you so much for that really kind introduction. i'm honored, and again, i want to thank the conference organizers for inviting me to be here today. in july of 1938, the roosevelt administration organized a national conference on health care reform. the great depression had been going on for nearly a decade, fdr signed the social security act and the fair labor standard act in to law, but the united states still had no national program for addressing the health needs of the people. the 1938 health conference was beginning of something different. instead of inviting only doctors to speak, the conference for the first time including members of labor unions, farm groups, and civil rights organizations.
it included represents not just of the medical profession, but of the people who needed and used health care. that summer a woman named florence greenberg traveled from chicago, illinois to washington to offer her testimony. greenberg was a member of the women's auxiliary spending her days working in the communities around chicago's steel mills. greenberg told the audience that the national health conference that he had come to offer them a different picture of chicago. just steps away from the comfortable headquarter of the american medical association, was a chicago of dirt, filth, and tenements, of sick chicago where people struggled with terrible health con decisions relatedded to poverty and
unemployment and struggled to obtain baiivel medical care. the overcrowded cook county hospital. the city's only hospital which locals described as death house. a single overcrowded private hospital served the entire african-american community of the south side. chicago's outpatient clinics were fill the to busting. she spoke with people too sick to leave their homes or couldn't afford the few pen if penny for transportation to a clinic. she told the audience about the child with that mown ya after being trurned -- an behalf of the working people of chicago, florence greenberg made the following demand, we're
asking our government to take health from the list of luxuries to be bought only with money and add to the list containing inalienable rights of every citizens. we don't know whether franklin roosevelt ever heard about her call for health care of the right, because even though he had endorse the the conference, he choose that time to go on vacation. fdr was on a cruise i guess we can't blame him. probably well deserved vacation, three years earlier he had refused to include medical coverage as part of the social security act because he at any time didn't want to antagonize the american medical message. he sent a message of support but the outbreak of world war ii
forced president's attention elsewhere. five years later on january 11, 19 e, in the state of the union address he spoke to the american people about the war and especially about the kind of peace allies planned to establish after the defeat of fishism. he said the one objective can be summed up in one word, security. and that means not only physical security which provides safety from attacks by aggressors, it means also economic secureity and social security. the individual political rights upon which the united states had been built roosevelt argued were necessary but not sufficient to guarantee true freedom and security. fdr announced an economic bill of rights which is sometimes called the second bill of rights that included the righted a job and living wage, the right to
housing, education, and security and old age, and a right to adequate medical care and an opportunity achieve and enjoy good health. so even though fdr missed hearing her speech, we hear echoes of it in the second bill of right. the idea of economic and social rights is essential supplement to political rights started at the french revolution, but the idea of right to medical care was something more recent. discussion of the kind of right became promise inept in in the 1930s and '40s medical care itself was becoming more effective. it was starting to matter much more in everyone's lives. by the 40- '40s they knew about the medical miracles like vaccination, penicillin,
antiacceptic surgeries that could save life. to withhold the miracles seemed unjust. medical care at this time was starting to cost more than ever before. the average family could not pay for a hospital stay or major illness or the birth of child out of the wages. so medical care had become not just a matter of life and health, it was also becoming something that could cause serious financial heartship. that's why it t became a matter of economic security as well as health security. in the u.s. demands for medical care as a social right originated in the worker's movement represented by people like florence greenberg. next came to national prominence in fdr's proposed second bill of rights, and finally they were adopted in the united nations
universal decoration of human rights after world world war ii thanks in part to el mrs. roosevelt after her husband's death. today more than 70 countries recognize a right health or health care in their constitutions. virtually every industrialized nation have taken steps to implement the rights by establishing some type of universal health coverage for their citizens. with one major exception, anybody know? [inaudible] the united states of america. but it's not for lack of trying, after fdr's death president harry truman announced a national health insurance program that would have made it part of the social security act. the physicians of the american medical association attacked the plan and socialized medicine
that might also sound familiar. and in the early cold war, the ama won that battle and truman's proposal was defeated. other presidents ?kding nixon and bill clinton tried to pass universal health care programs. but they failed due to entrenched and vigorous opposition not just the medical profession but also opposition from business and increasingly power insurance industry. health care reform in the u.s. was pronounced impossible. but then the impossible happened. and today we have the 2010 affordable care act or obamacare, which everybody is calling it now. so the passage of the affordable care act mean we have a right to health care in the united states?
the answer is not really. there are some important victories for rights in the law, the biggest one is the ban on insurance companies being able to exclude people from coverage because they have preexisting health conditions. the affordable care act will expand access to health coverage by providing federal sub i did who can't afford insurance on their own. even when the law is fully implemented, if it is fully implemented, i guess i should say. there will be a lot of people without health insurance. stilted db estimated to be up to 30 million remained uninsured and the estimate became higher than originally projected because of the supreme court decision last summer which will allow states to opt out of expanding medicaid. and although the affordable care
act creates new rights, there is still no universal right to medical care in america with one major exception, and that is the right to be seen in an emergency room. which is something we have been hearing a lot about recently. but a right to emergency care is not the same thing as not as substitute for is system that takes care of people's health and protect their economic security. so why, why is this the case? what has made the united states an outlier nation when it comes to the right to health care? i have been studying this question for a long time, even way back in the '90s. i'm sorry to say, although the historians won't be surprised to hear it. there's no single answer. my book tries to provide a few of the answers by analyzing the
history of the country's long tradition of access to unequal health care. i'm going to talk about some of the book's argument and give a couple more examples of women activists who have challenged the american system of unequal access in the tradition of felons greenberg. -- florence greenberg. so the subtitle of the book is rights and rations in the united states. i have already talked about right and how americans don't have them really when it comes to health care, in political argument you'll often hear that the u.s. may have a lot of problems with the health department system but at least we don't ration the way europeans and canadians do. have you -- you've heard this. you may have heard the argument that universal health care means a government bure karat will deny you life saving treatment
to save money for the system. we hear some people insisting that reform -- to the death panel and during the first presidential debate he warned of an unelected board that will deny treatments under obamacare. not only are these claims misleading at best, but they also imply that rationing or the denial of health care would be something new to our system. something extremely un-american. but i believe that the claim that the u.s. does not currently ration health care has been counter productive, damaging, and inaccurate. and my book uses historical evidence to show that the u.s. has rationed health care and has done for so for a long time. way europeans through canadians there do through waiting room and caps on national
expendture. the country allocated and denied health care in a complex and unique way called the american way of rationing. so what is the american way of rationing? and how can history help us understand it? in classical economics, rationing simply means the good and services are distributed by price. in order not everybody can afford everything they could possibly want or need. so supply and demand are controlled by people's ability to pay. rationing by price or rationing by the market certainly goes a long way to describe the u.s. health care delivery system. the government may not officially deny you health care. many americans cannot get the care they need because they can't afford it. and the u.s. health system until 1984, it was legal for hospitals to turn away patients because they could not pay. and that is still true in the case of nonemergency
conditions. we have a huge number of studies shows that economic barriers lead to people not being able to primary preventive care and reduced life expectancy. the u.s. rations health care base order the ability to pay. people without health insurance have more trouble getting care or don't get it at all with severe consequences for their health. that is not the whole story of the american way of rationing. i show in my book that the u.s. has rationed health care in many other ways by race, by region or location, by type of insurance coverage, by health conditions, by age, by marriage status, by gender, and the list actually goes on. i'm going to give a few example of history from the various types of rationing.
starting with race. you're probably all aware that a jim crow system exibs existed in health care as it did elsewhere in the south. but you know that separate unequal hospital system was built and paid for with federal funding? the hill burt ton act of 1946 which allocated billions in federal $s to expand -- including a special provision allowing southern hospital to separate black and white patients. there are cases on record of patients dying and women giving birth in the hospital parking lot because of segregated black section of the hospital was full even if there was room in the white section. in the north, there was another kind of rations by race inspect in chicago balances would take
african-american emergency maishts to the public hospital, even if a private hospital was much closer. and people died because of this practice. even after official discrimination was outlawed, other types of rations by race continued. for example, the flight of hospital from inner city neighborhoods to mostly white suburbs. the u.s. health care system also rations by employment or job status. after the defeat of the truman national health plan in the '40s. instead of universal health care we developed a system of private health insurance provided as a system of employment and supported by the federal tax code. and this is still how most americans get their health care today. health coverage -- so insurance coverage and ak sses to --
access depend on whether you're employed or whether you're employed. -- what kind and how much of a cost your employer is willing or able to cover. a system based on employer health coverage excludes a lot of people. people who work for smaller employers, the unempl women who temporarily leave the work force to have children, the poor, and the retired don't have access to insurance provided by an employer. rationing by employment means that people who retire lose coverage at the time they probably start to need it the most. and it was this flaw in the employment-based health system that helped lead to the creation of medicare in 1965. but medicare itself is a system of rationing by age.
there's no logical reason to give all people over 65 a completely different kind of health coverage than people under 65 except that is the way the health system evolved. creating incremental programs to try to cover the gap. we have a different system for the poor. medicare. which rations some of the ancient method of all. the means test to determine if you're poor enough to be eligible for the program. how would you are, how poor you are, where you work, and of course, how much money you have. the answer to the questions determine what kind of health coverage and care are available to you in the health care system if any is available to you at all. so do we still think the u.s. doesn't ration? we have entirely separate health
care systems for veterans and native americans. we have public and private hospitals, doctors who accept medicare or refuse medicare. doctors and hospitals that are in your networking or out of your nerving. access to care that is based not on how sick you are but on how much insurance you have. the right to care in an emergency room but not in a doctor's office. people getting too much medical care and people unable to see a doctor at all. the american way of rationing is complicated. it's confusing, and it's very irrational. and when you add it all up, this kind of rationing leads to a system that is the most expensive in the world. in the u.s. we spend over $8 ,000 per person on health care each year. nearly twice as much as dan and canada than germany more than
twice as much than britain and japan. rationing is supposed to lead of lower costs. but the american way of rationing costs a fortune. what do we get for the money? 41 countries have a higher life expectancy than the u.s., 40 countries have a lower infant mortality rate than we do. we have one of the poorest records of actually curing people of treatable diseases in the western world. and all of our spending still leaves millions without health coverage. does the affordable care act continue or does it disrupt the american way of rationing? i would say it does a little bit of both. but at 2500 pages it actually does a lot of both. first of all, by requiring insurance companies to accept people with preexisting
conditions, obamacare strikes a major below against rationing by health conditions. i don't think it's possible to overstate that significance of this, because it's basically telling insurance companies that they have to fundamentally change the way they do business. that their job is to cover sick people as well as healthy ones. imagine that. that is a big change for the american insurance industry. requiring everyone to buy health insurance or pay a fine the individual mandate is not exactly a right. it's more of an obligation. offering federal subsidies to otherwise couldn't afford the insurance goes some way of alleviating rationing coverage by act to pay. the law will also reduce rationing on the basis of gender, which i will talk more about in a little while. there are many important
provision in the act that will help tilt the balance toward more prevent i have care and access to pretheir care. -- primary care. there are many ways things will remain the same. the affordable care act, as i said earlier doesn't create universal coverage. and it bilged upon and leaves fairly intact a multitiered unequal health system of private insurance, public insurance, different for the poored and the employed, the unemployed, the young old, et. cetera. i don't mean to dismiss the achievement of the reform. historic and brings us closer to universal coverage than anything before. it doesn't change the system's fundamental nature of separating people in to many different categories in a way that is inefficient, very expensive, and in many ways unjust.
something else i write about in the book is the history of opposition to inequality and injustice in american health care. there has been a long and honorable beleaguer opposition. women activist have had a major impact on advancing the right to health care and critiquing the way of rationing in the past century. ..
except the american way of rationing and took a take a stand on behalf of health care as a right. so we are going to jump ahead three decades after florence greenberg. after the passage of medicare and medicaid, to september of 1970 when the american hospital association held its annual meeting in houston, texas. the american hospital association, or the aha, you may have heard of them. they're kind of like the ama of the hospitals. they are not as well is the ama but very powerful lobbying group on behalf of the interests of private hospitals in the u.s. for over a century.
the 1970 meeting of the aha turned out to be unlike any they ever had before because the hospital delegates were greeted by picket lines of mostly african-american women and children who were carrying signs and chanting things like, equal treatment for medicaid patients and hospital care for the poor. these picketers represented the national welfare rights organization, grassroots group with thousands of welfare recipients or welfare mothers as they were sometimes called an sometimes called themselves that as well. this meeting of the hospital association in 1970 was the first major action in the welfare rights movement campaign to stop discrimination against the poor in the health care system. the welfare mothers demanded to speak to the convention and eventually their request was granted. a woman named geraldine smith,
who was the national welfare financial secretary, got up in front of the convention and made an absolute blistering speech. she told the audience of hospital lobbyist that the american hospital association was hypocritical, selfish, provoke eiland patronized and the hospitals hide behind a screen of concern for the disadvantaged while perpetuating an unequal system of health care. she presented the delegates with a list of demands from the welfare rights movement. she told hospital officials to end the practice of dumping poor and uninsured patients or transferring them an unstable conditions. she demanded the establishment of clinics where people could attend instead of going to the emergency room. she called prayer requirements for all hospitals to accept medicaid patients. she demanded that patient
representatives and members of the community especially representatives of the poor should have a seat on the hospital board. she asked for informed consent about medical treatment and especially that all patients should be treated with dignity and respect. supposedly the audience of hospital officials listened very politely to all of this but when smith had finished speaking they went about their business at the convention as if nothing had happened. shortly after this meeting, the american hospital association began drafting the first patient bill of rights, which was eventually co-opted by hospitals all over the country and included a an an in crucial rights as geraldine smith had mentioned such is the right for patients to have informed consent. hospitals also began around this time to include community representatives on their governing boards. as you might imagine the aha bill of rights did not resemble
what the welfare rights l. of rights would have looked like. did not include any of their the rights to access to health care that geraldine had demanded and these bills certainly did not recognize a right to health care. but they did represent a turning point, the voices of patients could no longer be ignored. the welfare mothers invasion of the hospital meeting in 1970 brought the language of patient's rights into the mainstream health system for the first time. and my second example fits really well with last night's keynote address because she was an activist from detroit. her name is olga madar and she started working in auto plants in the 19 30s and became the first female member of the executive order of the united autoworkers. in the 70's madar was one of the founders of the coalition of
labor when unions and she became its president in 1974. as president, but darla the first national campaign against discrimination, against women by the private health-insurance industry. in a speech that was reported in newspapers around the country madar announced that insurance companies were charging women premiums as much as 150% higher than men's. insurers justify this practice by arguing that women had higher health. they describe us as clunkers said madar, like old cars. we break down. we are unreliable. we are out to defraud and bankrupt the insurance industry. madar pointed out that as well as charging women higher premiums insurance companies refuse to cover pregnancy and childbirth or offered only minimal coverage to with a very high expense.
because of the concept of moral hazard, pregnancy and childbirth were considered to be uninsurable conditions because women supposedly planned them in advance and you're not supposed to buy health insurance knowing that you are going to use it. that is really what they said. [laughter] some companies covered maternity. some companies to cover maternity but only for the wives of male employees while the male workers were denied coverage. comprehensive coverage return to these services as late as 1970s the 1970s was virtually nonexistent. madar apostolakis did this him against gender bias in health insurance led to the passage of the discrimination act of 1978 which would require large employers to include maternity coverage in their health plans. but like all health reforms in
the u.s., these new rights only helped some of the population. the small group and individual health insurance markets words were the only option to people not working for large employers continued to blatantly discriminate against women. until 2012, until this year, a majority of individual health insurance plans charged women more than men, a practice called gender of rating and most of these plans even charged women non-smokers more than males who were smokers. and a majority of individual insurance plans through this year still excluded maternity coverage. but this year important provisions of the affordable care act took effect that would ban many types of gender discrimination in the insurance market. the law doesn't stop
discrimination entirely. abortion services are placed in a special category and states can ban abortion coverage altogether. but the law still contains many provisions that need to to and rationing by gender. all new health care plans would be required to charge men and women equally and to include coverage from -- for maternity care. in addition since august the first of this year, obamacare requires all health insurance to cover many preventive and screening services for women, including mammograms, pap smears, prenatal care, lactation support, domestic violence screening and contraception. i think that these coverage expansions alongside the defendant and of gender rating and a ban on excluding preexisting conditions of the most truly historic aspects of
any law and they will make the greatest inroads against the american way of rationing. but we also have to ask why it took so long to get here and why it was so difficult. blatant gender discrimination survived until 2012, 100 years after progressive women reformers called for equal treatment of maternity in health-insurance. and as you all know we have made selection in which one party vows to repeal even those modest gains for equality and health coverage. the fight for health care in the united states is far from over. while all other affluent nations agreed long ago that basic health care should be a right of all citizens, the u.s. continues to treat medical care is a product purchased in the marketplace. even now the most sweeping reform in our history embodies this tension between the rights
of the people and the rights of private companies and individuals to profit from the health care system. the three women i've described in this talk lived at different times or in different parts of the country. they didn't know each other and had never even heard of each other, but what all three of them having, and was their belief that ordinary citizens could take the lead in preventing a new vision of what our health care system could be. i think that all three of them thought the affordable care act beside its flaws, believed continuing and open for kiss of vittori national debate about how the american health care system can best serve the needs of all of the people. thank you for listening. [applause]
we have time for questions in the way we will do this, beatrix will stand up there and i will come around. raise your hand if you have questions and i will come and find you. that definitive? >> thank you very much for a wonderful talk and i have purchased your book and i'm looking forward to reading it. my name is ann and i'm their recent dean of bricks college studies which women and gender
studies is a program at my college so i'm very happy to be here. i'm very interested in the idea of human rights and have read the book by eleanor roosevelt's role in the writing of the universal declaration of human rights and i'm wondering to what extent philosophical debates have played a role in the politics of the united states? i would expect probably not very much. but the united states was borne out of a philosophy, the political philosophy of our country, born out of the enlightenment values, endowed by our creator with basic rights of you know the pursuit of happiness, liberty and freedom and this was always at odds with the economic and cultural rights. so i'm wondering to what extent any debates have occurred in our history about what is a human
rights versus maybe other kinds of civil rights or economic rights? and the problem that problems that the right to health care is not seen as a human right, transcending what government may or may not do. >> thank you for defining as opposed to the human rights. human rights are meant to transcend rights etc. and it is true that the united states is taking a different approach, especially to economic, social and social rights as human rights. and i'm glad you read the book about eleanor roosevelt and the u.n. declaration that even eleanor roosevelt, i was surprised at how strongly she advocated for the inclusion of social rights in the declaration because i had expected the u.s.
stands to be much more focused on individual rights, what we would also consider negative rights and freedom from oppression and control by the state etc. but fdr was crucial including the social rights in the u.n. that duration but that did not resonate here. it didn't resonate and there were also organized groups that worked to oppose the acceptance of such rights. such as the medical profession and certain business groups etc.. there is was actually a specific campaign to prevent the u.s. from exempting the current economic and social rights in the '90s. that was run by a conservative group so i think there are a lot of ideological reasons.
but there has also been an organized -- to them. less than for no grounds for social rights as human rights in the u.s.. >> my question almost ends with the individual resistance to health care which i grew up in germany so it's hard to understand why people, even if they have illnesses or family members with chronic illnesses, why they are opposed to health care that actually would help them? and so that is an individual level among americans is very hard for me to understand so i'm wondering if you could talk a little bit more about that? >> well, in germany and correct me if i'm wrong, several other european countries there is a principle of solidarity, a word that rings true and that has been very explicit in their
political culture and is widely accepted, even i think among fairly conservative people, that when it comes to things like health, things that people have no control over, the principle of social solidarity takes precedence so people pay into it so everyone is covered and it has a very strong force against the acceptance of that idea of solidarity and it's important to know about the concept of solidarity because that helps make up a little bit more nuanced for the argument about oh all they do over their there socialism because there is a spectrum and solidarity is this very mainstream concept in europe i believe but that individualism leads do you know, you might see a neighbor suffering that maybe it's their fault. maybe they are not being right or not exercising or they have
done something and this is i think an example of of the way and evangelism can shape the health care debate in this country and that kind of takes form in the individual of the affordable care act mandate which is not again an admission of solidarity or that we are all in this together. it's the individual responsibility and application to purchase health insurance. >> i am chris with cherry st. health services, federally qualified health center. we are a country of about 310 million people and out of that, until very recently, about 55 or 60 million of those people did not have coverage. when the affordable care act, that number will be down to about 30 million people or so and if we fully implement the
affordable care act, that is supposed h. choose to have the additional medicaid coverage, we could be down to about 15 million who don't have coverage. that extension of medicaid comes at very little cost to the states involved. the system is already set up in the affordable care act to go into effect and to cover those costs if the states choose to move ahead with that. i find it inconceivable that we could deny 15 million more people coverage, and i also find it incredible that we are able to deceive people so much as to try to encourage them not to cover these additional people. do you have any comments on that and how it might work out?
>> the medicaid expansion? ideal and i would also like to talk for a second about community health centers. the affordable care act was intended as you said to pretty drastically reduce the number of uninsured in a country through two different mechanisms so instead of covering everybody it brings the image to mind of instead of the sweeping coverage you have coverage so it's going to be employer coverage and people are the half and there's going to be a segment of the uninsured who are not poor enough to qualify for medicaid so they will be subject to the individual mandate and then for the poor and up to 330% above the poverty level which is a significant rise in the requirements for medicaid would be covered by this expansion. as i mentioned, the expansion
was not upheld by the supreme court last summer so even though states can go ahead with it, still in the law as you said states are now able to opt out of it and several have already done so. texas being one of them saying we don't want this money even though it is free money for the first several years for the states from the federal government. so the states that are refusing this are saying so it's going to be too expensive in the long run but it's hard to imagine that there is not some sort of ideological component to their refusal because it is kind of a no-brainer. is a cheap way of covering a lot more people and so now instead of having, there will be a gap thereafter these new types of coverage so now we are going to have this but medicaid coverage is going to go way down to the gap is going to be that much
bigger. i did mention that provision for community health centers and the loss. is your center going to be affected at all? getting a lot more money for these community-based clinics now. do you have anything to add? i am curious how it's affecting you. >> expanding our services considerably with a couple of new clinics including one that is opening up monday. but, i think one of the other issues besides the coverage is the fact day you can have a medicaid card for example, but if there aren't enough other places, enough places that accept medicaid coverage, you still don't get care so this is a provision of the act that allows community health centers and other preventive oriented
agencies to open their doors a little bit so people can use that coverage. >> great. thanks. we have time for one more question over here and then i just want to remind people that we have books for sale outside and we have -- so i will just have you come right up here for the last question. >> i have a question about the women activists and whether you just chose women activists because women and gender historians of the midwest are women in the vanguard of this kind of pushing back against what they perceive to be inequitable treatment and if so, why or why not? >> i guess they have been. i didn't do it on purpose. they came to me for a historical record. when i wrote my first book on progressive era health reform i didn't expect to be writing a lot about teddy roosevelt and he is in there but it was these
women government workers and union organizers in new york city who were really, they were starting their own community health clinics in new york and they didn't use the language of rights at the time but they'd definitely talked in terms of universalism and that everybody should have access to care, not just those who are unionized. does their gender make them more of the vanguard cracks in some ways i think there are some connections. the maternity issue has always been a bit once i think a lot of these critiques of the american way of rationing have been routed and women's experiences with health care and health care needs that women have, so maternity coverage, care for children was the impetus behind the shepherd act from the 1920s, the public health act
and of course the movement for reproductive rights have at times attention has been paid to this but we care much less about how reproductive rights activism is also about health care for all come, for everybody. women were demanding these particular reproductive services but i think that the type of activism again, routed in experiences have led to a really strong stand for universalism and health care rights. >> we are going to have to stop there. >> thank you so much. [applause] >> for more information visit the author's web site, beatrix hoffman.com. >> america ranks 25,000 feet of
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